Communications with Non-English Speakers
How do I communicate with families that are not English proficient?
Language access is critical for ensuring that immigrant children and families are able to access and use health care services. 82% of immigrant children are fluent English speakers, however 40% of immigrant children live with at least one parent that does not speak English fluently. Approximately 24% of immigrant children live in a linguistically isolated household where no one over age 13 speaks English fluently in the home (1).
Families that are not fluent in English and cannot access language support may be deterred from making appointments for health care services. In health care settings, language barriers can lead to inadequate communication that may cause confusion, dissatisfaction, and/or medical errors (2,3). Language barriers have been linked to less routine and timely care for children whose parents’ primary language at home is not English (4).
Language barriers can occur in clinical settings from the outpatient clinic to the intensive care unit, or in non-clinical settings, like administrative, billing, and legal departments.
Trained medical interpreters can help pediatricians communicate with families that do not speak English or have limited English proficiency. Trained medical interpreters are valuable assets to the health care team and essential bridges to navigating language barriers. Trained medical interpreters may include trained bi-lingual staff, on-staff interpreters, contract interpreters, or telephone interpreters.
Trained bi-lingual staff are employed by the practice for a different primary role and have interpreter duties as a secondary role. On-staff interpreters are employed by the practice solely for interpreter services. Contract interpreters are not employed by the practice, and provide services on an on-call basis. Telephone interpreters provide services through telephone language lines, often providing interpretation for less commonly requested languages. Although less common than telephone services, interpretation services can also be provided through Video Medical Interpretation
Best practices for working with medical interpreters:
- Treat interpreters as an important member of the health care team.
- Provide the interpreter with a brief summary of the patient and briefly share what is anticipated and what will be covered during the visit.
- Establish and maintain eye contact with the parent or patient.
- Speak slowly, clearly, and concisely, with appropriate time for interpretation. Try to avoid jargon.
- Avoid interrupting the interpreter once the session has started.
- Pay attention to the parent and patient’s body language and other non-verbal cues.
- De-brief with the interpreter after the patient visit.
Best practices for working with families with limited English proficiency:
- Determine a family’s preferred language. To determine the patient’s or family’s language of preference, provide a brief language identification document with a simple sentence in many different languages.
- Unless you are fluent in the patient’s preferred language, do not attempt to speak that language with a patient.
- Avoid using family members, particularly children, as interpreters. Untrained interpreters may not accurately interpret information which can lead to misunderstandings, misdiagnoses, and medical errors. The most common interpretation errors involve omissions and editing of information. Children should not be used for interpretation for a variety of reasons including the potential for errors, omissions, and the potential for burdening the child or creating role reversal within the family.
- Take caution when asking patients to read English-language information or to complete forms in English, when English is not their primary language.
- Cervantes, Wendy and Hernandez, Donald. March 2011. Children in Immigrant Families: Ensuring Opportunity for Every Child in America. First Focus.
- Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60-67.
- Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6-14.
- Galbraith AA, et al Language disparities and timely care for children in managed care Medicaid. Am J Manag Care. 2008 Jul;14(7):417-26.
U.S. Department of Commerce Bureau of the Census. United States Census 2000. Language
Language Access Resources DC
Health care providers can
play an important role in:
- Providing and disseminating information about language access and immigrant rights
- Providing reassurance to families who may feel some discomfort or even shame regarding their lack of English proficiency
- Assuring families that language access services are available at no financial cost to the family
La Clínica del Pueblo provides medical services interpretation. In order to ensure equal access to healthcare for Limited English Proficient persons, La Clínica provides medical interpretation in over eight languages on-site and at community health organizations and local hospitals. Families and/or providers can call La Clínica to arrange for medical interpretation. Interpretation is arranged prior to appointments. For more information and contact information please refer to their website.
Many Languages One Voice
Fosters leadership and facilitates community-led initiatives to increase the meaningful inclusion of immigrants in the District of Columbia who do not speak English as their primary language. MLOV is a member of the DC Language Access Coalition
DC Interpretation & Translation
Learn more about advocacy efforts around interpretation and translation services in DC